Ten simultaneous bilateral total knee replacements were compared with ten unilateral total knee replacements in osteoarthritic knee. All procedures were performed using same preoperative, intraoperative and postoperative protocols. Results showed that simultaneous bilateral TKR had higher incidence of medical complications, more requirements of blood transfusion and raised temperature of more than 1000 F for more than 48 hours, although there were advantages of simultaneous bilateral TKR in terms of decreased hospital stay, better utilization of scarce hospital resources, early rehabilitation and no risk of second anesthesia. The true safety and efficacy of simultaneous bilateral TKR needs further evaluation.

The neurologic outcome of posterior fixation of thoracolumbar spine fractures

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Manish Garg, Sudhir Kumar

Thirtyfive patient with unstable fractures of the lower thoracic and lumbar spine managed uniformly with Hartshill fixation and sublaminar wiring were analyzed. On admission, 18 patients had complete neurologic deficit and 17 had incomplete lesions. The neurologic recovery and functional activities were assessed after an average follow up for 20.4 months. Improvement of neural function was seen in 71 % patients. Positive correlation was found between the level of injury and Frankel grades. The cord lesions tended to demonstrate more severe neurologic deficit than cauda equina lesions. A component of dislocation to the injury also resulted in a more severe neural deficit. The complications were minor. Stable fixation of thoracolumbar spine fractures was helpful in decreasing hospital stay and recumbency period, thereby facilitating early rehabilitation of the spine injured patients.

A prospective study was carried out to determine incidence rates and distributions of various parameters associated with scoliosis amongst school children of lower Assam, India. A total of 16,912 children (9,274 girls and 7,638 boys) between five to 16 years were screened using the Adams forward bending test. The average age of children with positive findings at the time of examination was 10.6 years and the highest number of cases was observed in the age group of 11-13 years. The results showed that the incidence rate of scoliosis in this study was 0.2 percent with a female to male radio of 2.2: 1. Idiopathic variety was the most common aetiological curve type and the most common curve location was thoracic. In approximately 72 percent of cases the patients / parents were unaware of their deformity.

Twenty five patients with 26 tibial plateau fractures were treated with closed reduction by ligamentotaxis and minimal internal fixation with screws / wires, under C-arm image intensifier control. Patients were evaluated at a mean of 26 months after injury. Union was achieved in all the fractures with an average duration of 12.08 weeks. The average range of motion was 107.8. Partial weight bearing was allowed approximately at 8-12 weeks (average 8.92 weeks) and full weight bearing after complete union of fracture (average 13.12 weeks). Ninety two percent of the patients had satisfactory outcome using Rasmussen's criteria. We conclude that the technique is more biological, requires less surgical time and hospital stay and is devoid of major complications and leads to a better functional outcome.

Over an 8 years study period, the author had an opportunity to evaluate a large number of patients with complex thoracic and thoracolumbar deformities of varied etiology. Of these 127 were treated surgically [scoliosis: 78 and hyperkyphosis :49]. These deformities were operated for a variety of indications, viz: relentless progression, risk of future neurological deficit, progressive cardiorespiratory compromise, and cosmesis. The various etiologies of these cases, along with their treatment protocols have been analyzed and presented in this paper. Various approaches and implants that we used in the surgery of these patients have also been discussed.
A specific protocol for management was devised based on the following variables:

The etiopathology of the deformity and its natural history [viz: idiopathic, congenital, neuromuscular, nerofibromatosis, etc].

The timing of surgery.[emergency, semi- elective, elective, etc],

The appropriate surgical approach [anterior, posterior or combined]

The implant and instrumentation: which implant design would be the ideal one in terms of user friendliness, simplicity of design and affordability,

The fusion: the technique, the mandatory fusion levels, choice of grafts and bone substitutes if any?

The postoperative protocol for mobilization and role of bracing.

The safety factor: surgery for complex spinal deformities although rewarding is extremely "high risk" and could result in unforgiving neurological compromise either transient or permanent. This specific factor needs to be extensively discussed, preoperatively, with the patient and his family in the true context of the risk benefit ratio, before assuming responsibility for its management. Use of pre and intraoperative spinal cord monitoring [somatosensory evoked potentials] has been extremely helpful in this regard.

Hip pain due to arthritis is a common problem. Total hip arthroplasty is successful but failure still cannot be excluded. Since resources are scarce, alternative methods are looked for. We have described the alternative and to encourage to consider economic evaluation in the future. We have treated 560 patients (717 hips) hip joint-disease-pain with the new non-surgical treatment. On the basis of the results the use of the enzyme appear to be successful alternative treatment.